HomeMy WebLinkAboutMortgage_Carlisle r . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATIOOf I T . E 1I State Form 43709(R11/6-09) gN
Prescnbed by Department of Local Government Finance
p i File Mark
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INSTRUCTIONS: JAN 2014 I Form Med with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the propeny is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. i County Auditor BP 2) Mobile/Manufactured Homes not assessed as Real Property Must file d the h lye the
before March 31 of each year the deduction is sought )fjly County Recorder
See reverse side for additional instructions and qualifications. `gyp o , G�IBo�rONCOUNTYAUDITOR
Apr (owner or contrarl6uygr-see�G reverse side) \COI IU-A— --�
Ta Disbici I.
number/legal d
Record number Page number
�T� a ,- 13-Z I 106 O 033 00A] WO\-k
Assessed vahre of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid it Is the appfrant the sole
Mann 1,cvrent year March 1, t year date of application I legal or equitable owner?
�� i ❑ Yes ❑ NO
If no,what is his/her exact share of interest? If owned with someone other than spouse.i dioate with whom
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If name on record is dd:erent than that of applicant indicate below Is the property in question:Annually Assessed
Jo Real.Property_❑Amuafy Assessed
Name of mortgagee or contract seder
q1/43
31172/-73(t: PA/ Q K A
Address o mortgagee f moagee or contract seder(number and street,city,state,and ZIP code) ) .
Name of assignee or other owner or holder of mortgage 8E,I Ty S
Address of assignee(number and street,city,state,and ZIP code) —kr /y L) // iJ le
I .fT^�7J l A.-/Lr`
Does applicant own property in any other If yes,what county? . What Tr r I t t I
county in Indiana? l❑ Yes El No yTr,69 D U 1U �
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COUNTY AUDITI _
Deduction approved in the annum oh i:3 (0 11, (�7// /
20 20 20 20 l/�/, _
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Signature of County Auditor - County I Lute(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contact buyer of the aforementioned property on date application is filed.
nature(owner's hit name) Date(month,day,year)
F resident address of applicant(number and street aay,state,and ZIP code)
I
7 ? $�/ F' R4 >�t
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street city,Waft and ZIP code)
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